. 2020 Oct 7;39(2):181–209. doi: 10.1007/s40273-020-00965-9

Table 5.

Quality appraisal of cost-effectiveness analyses of drugs for osteoporosis using the ESCEO-IOF guideline

Item	Recommendation	Article references
Item	Recommendation	[12]	[32]	[36]	[17]	[34]	[33]	[21]	[10]	[26]	[25]	[11]	[22]	[31]
Type of economic evaluation	Cost-utility analysis using QALY as the outcome	No	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes
Method for the conduct of an economic evaluation	A model-based economic evaluation	No	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes
Modeling technique	Lifetime horizon	No	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes
	Markov model is appropriate (6-month/1-year cycle length)	No	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes
	Avoid hierarchy of fractures and restrictions after fracture events	NA	Part	Part	No	Yes	Yes	Part	NA	Part	No	No	Part	Yes
	Hip, clinical vertebral, and non-vertebral non-hip fracture	Yes	Yes	Yes	Yes	Yes	Part	Yes	Part	Yes	Yes	No	Yes	Yes
Base-case analysis and population	Multiple scenarios: age range, BMD, and fracture risk scenarios	No	Yes	Part	Part	Part	No	No	No	No	Yes	No	No	Part
	The FRAX^® or GARVAN^® tools can be used to model fracture
	Increased risk after fracture events within the model	No	Yes	Yes	No	Yes	No	No	No	No	Yes	No	No	Yes
Mortality	Excess mortality after hip fractures and clinical vertebral fractures	No	Yes	Yes	No	No	Part	Yes	No	No	Yes	No	Yes	Yes
Mortality	Proportion attributed to the fracture (e.g., 25–30%) mortality that is attributable to the fracture event	No	No	No	No	No	Yes	Yes	No	No	No	No	No	No
Fracture costs and utility	Societal and/or healthcare payer perspective	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes
	Acute fracture costs	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes
	Long-term costs after hip fracture (attributable to the fracture)	No	Yes	Yes	No	Yes	Yes	Yes	No	No	Yes	No	Yes	Yes
	First year and subsequent years’ effects of fractures on disutility	No	Part	Yes	No	Yes	Part	Yes	No	Yes	Yes	No	Yes	Yes
	National ICUROS data if available
	An additional effect (on costs and/or utility) after multiple fractures	No	No	No	No	No	No	No	No	No	Yes	No	No	No
Treatment characteristics	Treatment duration similar to guidelines or RCTs	Yes	Yes	Yes	No	Yes	NA	Yes	No	Yes	Yes	No	Yes	Yes
	Comparators: no treatment and relevant active osteoporotic agent(s)	Yes	No	Yes	No	Yes	No	No	No	No	Yes	No	No	No
	Sequential therapy may be considered as intervention/comparators
	Efficacy data from RCTs, (network) meta-analysis	No	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes
	In the absence of hip/wrist specific efficacy data, use of non-vertebral or clinical fracture efficacy data
	Treatment effects after discontinuation depending on treatment	No	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes
	Medication adherence as base case or sensitivity	No	Yes	No	No	Yes	No	No	No	No	No	No	No	Yes
	Drug costs and administration/monitoring costs	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
	Adverse events	No	Yes	Yes	No	No	No	No	Yes	Yes	No	No	No	No
Sensitivity analyses	One-way sensitivity analyses	No	Yes	Yes	No	Yes	Yes	Yes	No	No	Yes	No	Yes	Yes
Sensitivity analyses	Probabilistic sensitivity analyses	No	No	Yes	No	No	Yes	Yes	No	Yes	Yes	No	Yes	Yes
Outcomes	Presentation of disaggregated outcomes, incremental costs, and outcomes for each intervention and incremental cost-effectiveness ratios	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes
Scoring		7	20	21	5.5	19.5	16.5	18.5	4.5	15.5	21	2	17.5	20.5

Item	Recommendation	Article references
Item	Recommendation	[14]	[13]	[18]	[19]	[30]	[35]	[29]	[23]	[24]	[27]	[15]	[28]	[16]	[20]
Type of economic evaluation	Cost-utility analysis using QALY as outcome	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Method for the conduct of economic evaluation	A model-based economic evaluation	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Modeling technique	Lifetime horizon	No	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes
	Markov model is appropriate (6-month/1-year cycle length)	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	NA	Yes
	Avoid hierarchy of fractures and restrictions after fracture events	Yes	No	Part	Part	Yes	Part	Part	Part	Part	Yes	Part	Yes	Part	Part
	Hip, clinical vertebral, and non-vertebral non-hip fracture	Yes	Yes	Part	Yes	Yes	Yes	Part	Yes	Yes	Yes	Part	Yes	Yes	Yes
Base-case analysis and population	Multiple scenarios: age range, BMD, and fracture risk scenarios	Part	No	Part	Part	Yes	No	Yes	Yes	Yes	Yes	No	Yes	Part	Part
	The FRAX^® or GARVAN^® tools can be used to model fracture
	Increased risk after fracture events within the model	Yes	No	Yes	Yes	Yes	No	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes
Mortality	Excess mortality after hip fractures and clinical vertebral fractures	Part	No	Part	Part	Part	Yes	Part	No	Yes	Yes	Yes	Yes	Part	Part
Mortality	Proportion attributed to the fracture (e.g., 25–30%) mortality that is attributable to the fracture event	No	No	Yes	Yes	No	Yes	No	No	No	Yes	No	Yes	No	Yes
Fracture costs and utility	Societal and/or healthcare payer perspective	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
	Acute fracture costs	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
	Long-term costs after hip fracture (attributable to the fracture)	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
	First year and subsequent years’ effects of fractures on disutility	Yes	Yes	Yes	Yes	Yes	Part	Yes	Yes	Part	Yes	Yes	Yes	Yes	Part
	National ICUROS data if available
	An additional effect (on costs and/or utility) after multiple fractures	Yes	No	No	No	No	No	No	Yes	No	Yes	No	Yes	No	No
Treatment characteristics	Treatment duration similar to guidelines or RCTs	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No
	Comparators: no treatment and relevant active osteoporotic agent(s)	No	No	Yes	Yes	No	No	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes
	Sequential therapy may be considered as intervention/comparators
	Efficacy data from RCTs, (network) meta-analysis	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
	In the absence of hip/wrist specific efficacy data, use of non-vertebral or clinical fracture efficacy data
	Treatment effects after discontinuation depending on treatment	Yes	No	Yes	Yes	Yes	Yes	Yes	No	No	Yes	Part	Yes	Yes	Yes
	Medication adherence as base case or sensitivity	Yes	No	Yes	Yes	Yes	No	Yes	No	No	Yes	No	Yes	Yes	Yes
	Drug costs and administration/monitoring costs	Yes	Yes	Yes	Yes	Yes	Part	Yes	Yes	Yes	Yes	Yes	Yes	Part	Yes
	Adverse events	No	No	No	No	No	No	No	Yes	No	No	No	Yes	Yes	No
Sensitivity analyses	One-way sensitivity analyses	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes
Sensitivity analyses	Probabilistic sensitivity analyses	Yes	No	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Outcomes	Presentation of disaggregated outcomes, incremental costs, and outcomes for each intervention and incremental cost-effectiveness ratios	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Scoring		20	11	21	21.5	20.5	15.5	20.5	19.5	18	24	16.5	25	20	20

Scoring: ‘use ICUROS data’, ‘use FRAX^® or GARVAN^® tools’, ‘consider sequential therapy as intervention’, and ‘in the absence of hip/wrist specific efficacy data, use of non-vertebral or clinical fracture efficacy data as replacement’ was not included in the scoring system

BMD bone mineral density, NA not applicable, QALY quality-adjusted life-year, RCTs randomized controlled trials